Abstract
BackgroundMalaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of IranMethodsIn this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages) were used to summarize the results and Chi square test was used to analyse data.ResultsAll but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly.The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless, only one-third of them [33% (95% CI: 0.00 - 67.8)] had updated inventory of malaria foci on quarterly basis.ConclusionTo sum up, malaria case management still constitutes a public health problem in Iran. Additionally, data suggest scarcity in management and evaluation of malaria foci, detection and control of malaria epidemics as well as assignment of emergency sites across different regions of the country. Consequently, massive and substantial investments need to be made at the Ministry of Health to coordinate national malaria control programmes towards achieving determined goals and targets.
Highlights
Malaria continues to be a global public health challenge, in developing countries
Characteristics of study units Data were collected from all 223 health facilities located in the selected districts to estimate health facility-based indicators, including detection and control of epidemics, management and evaluation of malaria foci and service delivery
Data were extracted from the profile of 5, 836 recorded malaria cases in aforementioned health centres during the year preceding the survey
Summary
Malaria continues to be a global public health challenge, in developing countries. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of Iran. The Ministry of Health and Medical Education in Iran has focused its effort on recommended guidelines by World Health Organization (WHO) [7,8,9] These strategies consist of early diagnosis and prompt effective antimalarial treatment; detection of malaria epidemics within one week of onset and have it controlled in less than a month; operational classification of malaria foci on quarterly basis. The present study was conducted to determine malaria indicators at the levels of health-treatment units and district health facilities and to investigate the quality of treatment of malaria cases in 20 malaria-affected districts in the three above-mentioned regions
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